Healthcare Provider Details

I. General information

NPI: 1679215933
Provider Name (Legal Business Name): GABRIELLA BLAZQUEZ DEESE DMD, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S MIAMI BLVD STE A
DURHAM NC
27703-0965
US

IV. Provider business mailing address

3020 S MIAMI BLVD STE A
DURHAM NC
27703-0965
US

V. Phone/Fax

Practice location:
  • Phone: 919-598-9900
  • Fax: 919-598-9500
Mailing address:
  • Phone: 919-598-9900
  • Fax: 919-598-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12711
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: